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Alzheimer/dementia and Long-Term Care

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The Alzheimer/Dementia disease is an irreversible, progressive brain disease that slowly destroys memory and cognitive skills, and ultimately affects the ability to carry out simple daily tasks. As people live longer as well as the demographic of over 65 increases over the next 20 years, this disease will be become an even greater challenge for our health care system in the United Sates of America due to the costly nature of this type of care.


In this paper the focus will be the Alzheimer disease and to some degree may use the terms Alzheimer and Dementia interchangeably, however there is a slight distinction. Many have referred to dementia as an umbrella that covers all types of cognitive decline (Thies & Bleiler 2013). In other words the Alzheimer's disease is a subset of dementia along with other types of these disorders. Dementia can be caused by quite a number of diseases and conditions. The following are some of the most common types:

? Primary dementias are characterized by the deterioration of the brain tissue itself. Included in this category are Alzheimer's disease, frontal lobe dementia, and Pick's disease. Fontal lobe dementia is caused by a disorder, which is usually genetic, that affects the front portion of the brain. Pick's disease, although rare, is a disorder that causes the loss of social skills, language, and memory, leading to personality changes and possible loss of moral judgment.

? Multi-infarct dementia is a vascular dementia caused by blood clots in the small blood vessels of the brain. Eventually the clots cut off the blood supply to the brain tissue so the brain cells end up being damaged and may even be destroyed.

? There are Dementia disorders caused by alcoholism or exposure to heavy metals.

? There are Dementia disorders caused by infectious diseases. Some of these diseases include HIV, viral encephalitis, Lyme disease, syphilis, and many more.

The reason the Dementia and Alzheimer's often are used interchangeably is because Alzheimer's is the most common form of dementia. The Alzheimer's Foundation states that up to 64% of all dementias are due to Alzheimer's (Thies & Bleiler 2013. However since it can only be definitively diagnosed with a post-mortem autopsy, Alzheimer's is usually diagnosed after other types of dementia have been ruled out so the percentage is an estimate.

Brief History

Really Dementia related disorders have been around even in ancient history in which the elderly have experienced signs of memory loss. It is well documented in ancient medical texts concerning people in advanced age exhibiting some signs of dementia and the physicians of that day prescribed various treatments from changing diet to bloodletting. Of course we no longer use bloodletting for such things in today's modern medicine; however diet continues to be a useful tool (Peterson 2008).

However the actual discovery or putting a so called label on it happened in the early 1900's. A physician named Alois Alzheimer provided care for a patient with a rapidly declining severe dementia disorder. After she past away, he performed an autopsy on her brain. Because of the recent advances of his day in histology and microscopy, Alois Alzheimer was able to study, in detail, the cellular changes in the nervous tissue of the brain. From this he found an atrophy of the gray matter surrounding the brain. He also discovered bundles of neurofibers and the plaques that are now a distinguishing characteristic for a definitive diagnosis of what is called Alzheimer's disease today (Cipriani 2011).

Since Alois Alzheimer's discovery, there have been many scientific breakthroughs in the research of this disease. In the 1960's, scientists discovered a link between cognitive decline and the number of plaques and tangles in the brain. Shortly after that the medical community formally recognized Alzheimer's as a disease and not just a normal part of aging. In the 1970's, the Alzheimer disease emerged as a significant area of research interest. This increased attention led in the 1990's to important discoveries and a better understanding of complex nerve cells in the brains of Alzheimer patients. Since then as more gene research has been performed, several drugs have been approved to treat the symptoms of this disease.

Alzheimer Care

The quality of delivered services in a long-term care setting is one of the most fundamental and important parts in offering sustainable living for people with Alzheimer's. There are several options for these long-term care settings. Listed below are several of the traditional settings:

? Adult day services provide social activities and meals as well as intensive health care services and therapy for people who have severe health issues or need medical attention throughout the day. Many specialize in the care for dementia as almost half of seniors at adult day centers have dementia.

? Assisted living and residential care are housing facilities that provide supervision or assistance with activities of daily living for people with conditions that handicap themselves from doing so which includes dementia. It is believed that approximately Forty-two percent of residents in assisted living and residential care facilities have dementia disorders.

? Nursing homes are also residential health care facilities that provide nursing care and supervision twenty-four hours per day, however they are generally for more complex issues than assisted living and residential care facilities. Statistics show that 68 percent have some degree of cognitive impairment of which twenty-seven percent have very mild to mild cognitive impairment, and 41 percent have moderate to severe cognitive impairment.

? Alzheimer's special care units are separate units within a nursing home that has special services for individuals with Alzheimer's and other dementias. There were a total of 79,937 of these beds in Alzheimer's special care units as of June 2012.which accounted for 72 percent of all special care unit beds and 5 percent of all nursing home beds.

? Last but not least is home care. What is meant by home care in this case is the care given by unpaid caregivers which is normally family members. According to many state home care programs, at least 37 percent of the elderly receiving non-medical care services have some degree of cognitive impairment.

As the Alzheimer's disease advances many may feel that adult day care, assisted living, and residential care facilities may not be adequate to fulfill the needs of these dementia patients. Home care is preferred for many reasons; however as in the facilities listed above once their needs become greater than the ability of home care to serve them and the capacity of the family to provide informal support it will be necessary to take steps to move them to the next level of care whatever that may be. Often that next step is nursing homes. However, nursing homes come with a stigma that causes many to pause (Werner 2008). Caregivers have a reason to be concerned about placing their love ones in such a setting. It has been known for some time that relocation not only to but also within the nursing home can have serious effects. However even though 67 percent of dementia related deaths occur in nursing homes, some studies have suggested that Alzheimer patients had a longer mean length of stay overall as compared to those who die in the nursing homes from other complications (Peterson 2008).

Future Challenges

The future challenges in Alzheimer/Dementia care are the same challenges we face with other health care issues in the United States of America. Among these challenges are our aging population, financing the costs, and workforce shortages. An estimated 5.2 million Americans of all ages have Alzheimer's disease (Thies & Bleiler 2013). It is estimated the break down is as follows:

? 11 percent of the population over 65 in this country has the Alzheimer's disease.

? 32 percent of the population over 85 in this country has the Alzheimer's disease.

? 4 percent of the population under 65 in this country has the Alzheimer's disease.

Due to people living longer on average it is expected that the Alzheimer population will grow drastically. By 2030, all baby boomers will be at least 65 years old. Because of this it is expected that that the Alzheimer's population will increase 50 percent to 7.7 million. Many feel by the year 2050 that number will increase to approximately 14 million (Thies & Bleiler 2013).

The sheer increase in numbers will add continued pressure on the cost of healthcare. Long-term care financing is a mix of public and private payments. Almost one-third of the money spent on long-term care is paid by the consumer. Medicare and Medicaid make up close to two-thirds as a payment source. However Medicare does not pay for custodial and non-skilled care. Medicare pays only for medically necessary in skilled nursing


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